DMHC Enters Settlement With Kaiser Permanente After Finding Repeated Failures to Provide Timely Mental Health Services

By Scott Glovsky on August 4th, 2017 in Autism Insurance Coverage, Class Action, Insurance, Insurance and Healthcare Denials, Insurance Bad Faith

Last month, the California Department of Managed Healthcare (“DMHC”), the California body charged with regulating managed health care plans, announced a settlement agreement with Kaiser Permanente, the trade name for Kaiser Foundation Health Plan, The Southern California Permanente Medical Group, and the Permanent Medical Group. The agreement followed and investigation by the DMHC finding repeated failures by Kaiser to provide members in California with timely access to mental health services. The agreement resulted from two years of discussions between the DMHC and Kaiser and has led to Kaiser’s commitment to hire an outside consultant for three years to improve access and policies governing its oversight of its behavior health programs.

The agreement includes promises from Kaiser to improve access by its members to the mental health services that they need like individual and regular psychotherapy. There is nothing in the agreement that would provide a remedy to existing Kaiser members who effectively had coverage for regular services like individual psychotherapy denied because they could not get timely appointments with a Kaiser provider or a therapist contracted with Kaiser. In Kaiser plans, members do not have access to outside mental health providers unless that provider is contracted with Kaiser and Kaiser refers that member to the outside provider. This means that if a member could not get an appointment in a timely manner then they could not get timely treatment. This settlement does nothing for those members who have gone without medically necessary treatment and without mental health/behavioral health care.
The agreement is also unlikely to remedy existing issues as the only threat for noncompliance are slap on the wrist fines that are inconsequential compared to Kaiser’s annual profits.

The Law Offices of Scott Glovsky and other lawyers also continue to pursue a class action lawsuit against Kaiser in order to improve behavioral health care for Kaiser members in California. The case, Dion v. Kaiser Foundation Health Plan, Case No. RG14718903 is currently being litigated in the Alameda Superior Court. It is our hope that we will continue to fight for the relief for consumers that are left out of the DMHC settlement. Please feel free to contact our firm if you have any questions about this case or if you have had issues (like denials or delays) getting health care from Kaiser or any other insurer in California.